The widespread use of highly active antiretroviral therapy may reduce the incidence of HIV in individuals and populations but has been overlooked by public health as a prevention strategy, write Dr. Julio Montaner and colleagues in CMAJ.

Despite advances in HIV treatment such as topical microbicides, pre- and post-exposure treatment and male circumcision, HIV infections continue to increase worldwide. Dr. Montaner and co-authors argue that "expanded access to highly active antiretroviral therapy for patients with a medical indication will reduce AIDS-related illness and deaths and may reduce HIV incidence."

"At the population level, access to highly active antiretroviral therapy has been temporally associated with substantial reductions in HIV incidence. For example, population-based research in Taiwan found a 53% reduction in new positive HIV test results after the introduction of free access to highly active antiretroviral therapy."

The use of "treatment as an aid to prevention" has been used in public health disease management, with diseases such as tuberculosis and genital herpes. "However, public health policy-makers and program managers have been reluctant to accept this strategy as viable for preventing the growth of the HIV/AIDS epidemic," write the authors.

"Treatment as an aid to prevention should be explored in diverse settings, including in developed and developing countries....Evidence derived from these research efforts will decrease AIDS-related morbidity and mortality and inform policy-makers about the role of treatment as an aid to prevention."

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